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Crit Care Med. 2019 Jun;47(6):e522-e529. doi: 10.1097/CCM.0000000000003728.

Prognostic Value of Glial Fibrillary Acidic Protein in Patients With Moderate and Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

Author information

1
CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Québec City, QC, Canada.
2
Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, QC, Canada.
3
Department of Medicine, Université Laval, Québec City, QC, Canada.
4
Department of Haematology and Medical Oncology, University of Manitoba, Winnipeg, MB, Canada.
5
Department of Social and Preventive Medicine, Université Laval, Québec City, QC, Canada.
6
Department of Medicine, Division of Critical Care, University of Ottawa, Ottawa, ON, Canada.
7
Center for Transfusion and Critical Care Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
8
Department of Molecular Biology, Medical Biochemistry and Pathology, Université Laval, Québec City, QC, Canada.
9
Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, QC, Canada.
10
Research Center of l'Hôtel-Dieu de Lévis, CISSS de Chaudières-Appalaches, Lévis, QC, Canada.
11
Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada.
12
CHU de Sherbrooke Research Center, Sherbrooke, QC, Canada.

Abstract

OBJECTIVES:

Biomarkers have been suggested as potential prognostic predictors following a moderate or severe traumatic brain injury but their prognostic accuracy is still uncertain. The objective of this systematic review is to assess the ability of the glial fibrillary acidic protein to predict prognosis in patients with moderate or severe traumatic brain injury.

DATA SOURCES:

MEDLINE, Embase, CENTRAL, and BIOSIS electronic databases and conference abstracts, bibliographies of selected studies, and narrative reviews were searched.

STUDY SELECTION:

Pairs of reviewers identified eligible studies. Cohort studies including greater than or equal to four patients with moderate or severe traumatic brain injury and reporting glial fibrillary acidic protein levels according to the outcomes of interest, namely Glasgow Outcome Scale or Extended Glasgow Outcome Scale, and mortality, were eligible.

DATA EXTRACTION:

Pairs of reviewers independently extracted data from the selected studies using a standardized case report form. Mean levels were log-transformed, and their differences were pooled with random effect models. Results are presented as geometric mean ratios. Methodologic quality, risk of bias, and applicability concerns of the included studies were assessed.

DATA SYNTHESIS:

Seven-thousand seven-hundred sixty-five citations were retrieved of which 15 studies were included in the systematic review (n = 1,070), and nine were included in the meta-analysis (n = 701). We found significant associations between glial fibrillary acidic protein serum levels and Glasgow Outcome Scale score less than or equal to 3 or Extended Glasgow Outcome Scale score less than or equal to 4 (six studies: geometric mean ratio 4.98 [95% CI, 2.19-11.13]; I = 94%) and between mortality (seven studies: geometric mean ratio 8.13 [95% CI, 3.89-17.00]; I = 99%).

CONCLUSIONS:

Serum glial fibrillary acidic protein levels were significantly higher in patients with an unfavorable prognosis. Glial fibrillary acidic protein has a potential for clinical bedside use in helping for prognostic assessment. Further research should focus on multimodal approaches including tissue biomarkers for prognostic evaluation in critically ill patients with traumatic brain injury.

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